Depression: Associated Conditions - Somatic Symptoms

Depression and somatic symptoms often go hand-in-hand. Somatic symptoms are symptoms that affect the body as opposed to symptoms that affect the mind. Some examples of somatic symptoms include changes in appetite, low energy, fatigue, low sex drive, dizziness, headaches, back pain, and belly problems. If healthcare providers cannot identify underlying psychological or physical problems that cause these types of somatic symptoms, people may receive a diagnosis of “Somatic Symptom Disorder”. Whether or not this diagnosis is given, it is clear that when depression and somatic symptoms occur together, it can be harder to understand the causes of both problems and tougher to get effective treatment.

Why Do Depression and Somatic Symptoms Occur Together?

There are several theories that address why depression and somatic symptoms go hand in hand. Some argue that somatic symptoms are the result of undiagnosed mental health problems and that people manifest their stress with physical symptoms. However, most experts in this area discuss research studies that argue against this theory. Instead, experts believe that the relationship between depression and somatic symptoms is best explained by underlying problems that lead to BOTH depression AND somatic symptoms. For example, a common theory (“Endocrine Dysregulation”) suggests that difficult experiences early in life cause a “burnout” in the stress hormone system due to overuse. Over time, the stress hormone system doesn’t work like it is supposed to, which increases risk for both depression and somatic symptoms.

What Does the Research Say About Co-occurring Depression and Somatic Symptoms?

The complex relationship between depression and somatic symptoms is not well understood. Even though we do not have all the answers yet, it is important to know that research has identified several consequences of co-occurring depression and somatic symptoms:

The majority of people who meet symptom criteria for depression will approach their Primary Care Provider with a somatic symptom, not with complaints about depression.

Somatic symptoms that occur with depression make it less likely for people to receive a diagnosis of depression. In fact, many people who have depression and somatic symptoms spend a lot of time (and money) trying to identify the underlying problems that give rise to somatic symptoms only to find that there is no clear answer.

Among people diagnosed with depression, somatic symptoms are more likely to be reported by children, pregnant women, the elderly, racial and ethnic minorities, those earning lower incomes, people with coexisting medical illnesses, and people in prison.

Compared to healthy people, those with somatic symptoms are more likely to develop depression and those with depression are more likely to develop somatic symptoms. It is also true that as the number of somatic symptoms increase, the risk of developing depression also increases.

Stigma around mental illness may cause some patients and even some providers to focus less on psychological problems like depression and focus more on physical problems like somatic symptoms.

Treatments for depression such as antidepressant medications are somewhat less effective for people who have somatic symptoms.

More research is needed to understand the complex relationship between depression and somatic symptoms. However, even with the current limitations in knowledge, many providers have expertise and success in treating co-occurring psychological and physical problems. Psychological treatments that have the best evidence for the treatment of these problems are Cognitive-Behavioral Therapy and Acceptance Commitment Therapy.